Although improvement of medical care has saved many very low birth weight (VLBW) infants who otherwise may have died, it also resulted in more infants with increased morbidities including bronchopulmonary dysplasia (BPD) and swallowing dysfunction (dysphagia). Once preterm infants approach 34 weeks postmenstrual age, oral feeding is initiated, since delayed initiation has been linked to numerous medical and developmental consequences. On the other hand, initiation of oral feeding in VLBW infants before the full maturation of their swallowing mechanisms can lead to aspiration into the lungs. Chronic aspiration results in a persistent inflammatory state, with disease progression to chronic lung injury and BPD that can be devastating for already fragile and developmentally immature lungs in preterm infants. It is estimated that 30-70% of VLBW preterm infants will have dysphagia. In spite of such a significant problem, there are limited therapeutic options for dysphagia management in VLBW infants during oral feeding. Available interventions in adults, such as pharmacotherapy and surgical interventions, are rarely an option in neonates. One alternate technique in adults is to use cold foods to stimulate a safer swallow. The use of cold stimulation activates a greater number of thermo-receptors within the oro-pharynx which consequently provides larger levels of input to the swallowing centers in the brainstem and results in improved feeding and swallowing movements. In adults, the use of cold liquids has been associated with a significant reduction in airway penetration and aspiration. However, the use of cold milk as a therapeutic option in preterm infants with dysphagia has not been evaluated leaving clinicians with very limited therapeutic options. The significant lack of dysphagia research in preterm infants hinders any evidence-based approach to such a common and substantial problem. The objective of this application is to identify preliminary evidence of the efficacy and safety of cold milk feeding for dysphagia management in VLBW infants. We hypothesize that oral feeding of cold milk in VLBW infants with dysphagia will improve suck/swallow/breathe coordination and decrease penetration and aspiration to the airway. We further hypothesize that cold milk intervention will have no adverse effects. In Aim 1 we will evaluate the effectiveness of cold milk to improve penetration/aspiration in VLBW preterm infants with dysphagia and in Aim 2, we will evaluate the safety of oral feeding of cold milk in preterm infants. To the best of our knowledge, there are no current published studies exploring the use of cold milk as a potential therapeutic intervention for dysphagia in VLBW infants. Success in our proposed studies will set the stage for a larger clinical trial that may change the paradigm of dysphagia management in preterm infants. Use of cold milk feeding will provide clinicians with a novel therapy that can impact clinical practice in NICUs throughout the country, thereby reducing the associated negative consequences of dysphagia, decreasing the length of stay, decreasing medical costs, and improving neonatal outcomes.